Term
|
Definition
| a transient gastric mucosal inflammatory process. In more severe cases there may be mucosal erosion, ulceration, hemorrhage, hematemesis, melena, or, rarely, massive blood loss. |
|
|
Term
| What will you see with an endoscope in a case of acute gastritis? |
|
Definition
| Endoscopically, you may see redness, erosions, & ulceration of the mucosa. |
|
|
Term
| Clinical features of acute gastritis. |
|
Definition
variable degrees of epigastric pain.
nausea & vomiting
GI blood loss (hematemesis/melena) |
|
|
Term
|
Definition
| black, tarry feces associated with gastrointestinal hemorrhage |
|
|
Term
| What would you see with a microscope if you looked at a biopsy of mild acute gastritis? Moderate/severe gastritis? |
|
Definition
Mild acute gastritis: the lamina propria shows moderate edema and slight vascular congestion.
The surface epithelium is intact. although scattered neutrophils may be present among the epithelial cells or within mucosal glands.
Moderate/severe gastritis: erosions (loss of superficial epithelium causing a defect in the mucosa that does not cross the muscularis mucosa); hemorrhage; acute inflammatory infiltrate, purulent exudate. |
|
|
Term
| What would you see with a microscope if you looked at a biopsy of healing gastritis? |
|
Definition
Epithelial regeneration
Elongation of gastric pit
Pseudostratified appearance of superficial epithelium
Residual cluster of neutrrophils in the gastric pit |
|
|
Term
| What is acute gastric ulceration? |
|
Definition
| discontinuity or break in stomach epithelium due to a transient gastric mucosal inflammatory process. |
|
|
Term
| Curling ulcers & cushing ulcers are two types of _________ ulcers |
|
Definition
|
|
Term
|
Definition
| an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to sloughing of the gastric mucosa |
|
|
Term
|
Definition
a gastric ulcer produced by elevated intracranial pressure; occurs in the stomach, distal esophagus, and proximal duodenum
One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to the increased intracranial pressure which leads to increased secretion of gastric acid. |
|
|
Term
|
Definition
| black, tarry feces associated with gastrointestinal hemorrhage |
|
|
Term
| Why are cushing ulcers (due to high intracranial pressure) a particular concern? |
|
Definition
| because they carry a high risk of perforation |
|
|
Term
Explain the following mnemonic:
CuRling is buRning
cuSHing is cruSHing |
|
Definition
curling ulcers are gastric stress ulcers from burns covering a large part of the body
cushing ulcers are due to high (crushing) intra-cranial pressure |
|
|
Term
| How do NSAIDs cause ulcers? |
|
Definition
NSAIDs block the synthesis of prostaglandins
Prostaglandins which enhance bicarbonate secretion, inhibit acid secretion, promote mucin synthesis, and increase vascular perfusion. |
|
|
Term
| What are 3 ways that high intracranial pressure is thought to lead to cushing's ulcers? |
|
Definition
1. high pressure directly stimulates the vagal nuclei, which causes hypersecretion of gastric acid.
2. Systemic acidosis, a frequent finding in these settings, may also contribute to mucosal injury by lowering the intracellular pH of mucosal cells.
3. Hypoxia and reduced blood flow caused by stress-induced splanchnic vasoconstriction also contributes to the pathogenesis of acute ulcers. |
|
|
Term
| If you looked at an acute gastric ulcer with an endoscope, what would it look like? |
|
Definition
Lesions described as acute gastric ulcers range in depth from shallow erosions caused by superficial epithelial damage to deeper lesions that penetrate the depth of the mucosa.
Acute ulcers are rounded, “punched out” lesion with very clean edges, less than 1 cm in diameter.
The ulcer base is frequently stained brown to black by acid digestion of extravasated blood and may be associated with transmural inflammation and local serositis. |
|
|
Term
| You see an ulcer in the stomach with an irregular shape and indistinct borders (it doesn't look "punched out"). What should you do? |
|
Definition
| take a biopsy Ulcers due to acute gastritis are usually round, "punched out" lesions with clear, clean edges. An appearance different than that could indicate cancer. |
|
|
Term
| What would you see with a microscope if you looked at a biopsy of an acute gastric ulcer? |
|
Definition
Microscopically, acute ulcers are sharply demarcated, with essentially normal adjacent mucosa.
Depending on the duration of the ulceration, there may be a suffusion of blood into the mucosa and submucosa and some inflammatory reaction.
Conspicuously absent are the scarring and thickening of blood vessels that characterize chronic peptic ulcers. |
|
|
Term
| Clinical features of acute gastric ulcers. |
|
Definition
variable degrees of epigastric pain
nausea and vomiting
I blood loss (hematemesis/melena)
gastric perforation
obstruction |
|
|
Term
| The most common cause of chronic gastritis |
|
Definition
H. pylori infection
(though it may be H. pylori + other factors) |
|
|
Term
| Your patient, who has recently recovered from an H. pylori infection, asks you if she should wear gloves while changing her cat's litter box to avoid re-infecting herself. Is that a good way to prevent H. pylori infection? Why or why not? |
|
Definition
No. Humans are the only known hosts of H. pylori.
(It's not known for sure, but transmission is most likely oral-oral or fecal-oral) |
|
|
Term
| What are some causes other than H. pylori (or along with H. pylori) that can contribute to chronic gastric ulcers? |
|
Definition
psychologic stress
caffeine
alcohol
tobacco
radiation injury
chronic bile reflux
mechanical injury
involvement by systemic disease such as Crohn disease, amyloidosis, or graft-versus-host disease |
|
|
Term
| Chronic gastritis is long-standing gastric mucosal inflammatory process that is usually secondary to: |
|
Definition
|
|
Term
What is amyloidosis?
What problems can amyloidosis of the stomach cause? |
|
Definition
a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues.
can contribute to chronic gastric ulcers |
|
|
Term
| What are risk factors, in the US, for H. pylori infection? |
|
Definition
poverty
household crowding
limited education
African-American or Mexican-American ethnicity
residence in rural areas
birth outside of the United States |
|
|
Term
|
Definition
| the portion of the stomach just proximal to the pyloric spincter (the bottom of the stomach) |
|
|
Term
| Where in the stomach does H. pylori mostly live? |
|
Definition
in the mucous of the stomach, mostly on the surface off the stomach, but some in the neck of the gastric pits (near the top).
Mostly in the antral part of the stomach. |
|
|
Term
| What will signs & symptoms will a person with chronic gastric ulcers show? |
|
Definition
variable degrees of epigastric pain
upper GI discomfort
nausea and vomiting
possibly GI blood loss (hematemesis/melena), gastric perforation, or obstruction |
|
|
Term
| Why is it advantageous to H. pylor that it produces urease? |
|
Definition
| urease generates ammonia from endogenous urea and thereby elevates local gastric pH |
|
|
Term
| How does H. pylori move through the stomach lumnen? |
|
Definition
|
|
Term
|
Definition
| Mucus producing cells which cover the inside of the stomach, helping protect it from the corrosive nature of the contents it contains. They are often found lining the gastric pits |
|
|
Term
| H. pylori have _______, which help them stick to foveolar cells in the stomach. |
|
Definition
adhesins
Foveolar cells are mucus producing cells which cover the inside of the stomach, helping protect it from the corrosive nature of the contents it contains. They are often found lining the gastric pits
|
|
|
Term
| What would you see with an endoscope if looking at a stomach with an active H. pylori infection? |
|
Definition
antral mucosa is usually erythematous and has a coarse or even nodular appearance. May show ulceration/erosions.
(remember, the antrum is the lower part of the stomach, between the body and the pylorus) |
|
|
Term
| What would you see with a microscope if looking at biopsy of a stomach with an active H. pylori infection? |
|
Definition
You would see flagellated bacteria within the superficial mucus overlying epithelial cells in the surface and neck regions
inflammatory infiltrate includes variable numbers of neutrophils within the lamina propria, including some that cross the basement membrane to assume an intraepithelial location and accumulate in the lumen of gastric pits to create pit abscesses
In addition, the superficial lamina propria includes large numbers of plasma cells, often in clusters or sheets, and increased numbers of lymphocytes and macrophages
Intraepithelial neutrophils and subepithelial plasma cells are characteristic of H. pylorigastritis. |
|
|
Term
| Autoimmune gastritis is characterized by antibodies against __________ cells & ____________ |
|
Definition
|
|
Term
| Auto-immune gastritis is characterized by reduced serum _________ concentration |
|
Definition
|
|
Term
| What kind of malnutrition does auto-immune gastritis cause, and why? |
|
Definition
vitamin B12 deficiency (pernicious anemia)
because auto-immune gastritis involves auto-antibodies against parietal cells (which produce intrinsic factor), as well as directly against intrinsic factor. Intrinsic factor is necessary for absoprtion of B12 |
|
|
Term
|
Definition
| when gastric acid is not produced in the stomach |
|
|
Term
|
Definition
| when less than normal amounts of gastric acid are produced in the stomach |
|
|
Term
| Would you expect stomach acid to be unusually high or unusually low in auto-immune gastritis. |
|
Definition
unusually low
(auto-immune gastritis includes auto-antibodies against parietal cells, which produce intrinsic factor and gastric acid) |
|
|
Term
| What 2 things do parietal cells produce? |
|
Definition
intrinsic factor
gastric acid |
|
|
Term
| What kind of cell in the stomach produces gastric acid? |
|
Definition
|
|
Term
| What 2 things do chief cells produce in the stomach? (one of them it doesn't produce all of the time) |
|
Definition
|
|
Term
| What is the purpose of rennin? |
|
Definition
| curdles milk in newborns, slowing down gastric emptying |
|
|
Term
| Explain how the urea breath test for H. pylori works. |
|
Definition
| Patients swallow a capsule containing urea made from an isotope of carbon. If H. pylori is present in the stomach, the urea is broken up and turned into carbon dioxide. Samples of exhaled breath are collected, and the isotopic carbon in the exhaled carbon dioxide is measured. |
|
|
Term
| What test would you most likely use to test for the presence of H. pylori? |
|
Definition
|
|
Term
| Mean age of diagnosis of auto-immune gastritis |
|
Definition
|
|
Term
| Which gender is at greater risk for auto-immune gastritis? |
|
Definition
women
(women are typically at greater risk for most auto-immune diseases) |
|
|
Term
| Auto-immune gastritis leads to hyperplasia of what cells, and why? |
|
Definition
G cells.
Autoimmune gastritis is associated with loss of parietal cells, which are responsible for secretion of gastric acid and intrinsic factor. The absence of acid production stimulates gastrin release (gastrin stimulates parietal cells to release gastric acid), resulting in hypergastrinemia and hyperplasia of antral gastrin-producing G cells.
(hyperplasia is proliferate; hypertrophy is getting bigger) |
|
|
Term
| What will you see if you look at the stomach of a person with auto-immune gastritis with an endoscope? |
|
Definition
diffuse mucosal damage of the acid-producing mucosa within the body and fundus of the stomach.
Loss of rugae. |
|
|
Term
| What would you see with a microscope if you looked at a biopsy of the stomach of a person with auto-immune gastritis? |
|
Definition
damage of acid-producing mucosa
infiltrate composed of lymphocytes, macrophages, and plasma cells.
Lymphoid aggregates may be present. |
|
|
Term
| What signs and symptoms would you expect from a person with auto-immune gastritis? |
|
Definition
variable degrees of epigastric pain, upper GI discomfort, nausea, and vomiting GI blood loss (hematemesis/melena)
Possibly gastric perforation or obstruction.
Patient may exhibit signs & symptoms of B12 deficiency (anemia, sub-acute combined degeneration of spinal cord).
Patient may also exhibit other auto-immune disorders like Hashimoto thyroiditis, insulin-dependent (type I) diabetes mellitus, Addison disease, primary ovarian failure, primary hypoparathyroidism, Graves disease, vitiligo, myasthenia gravis, and Lambert-Eaton syndrome. |
|
|
Term
|
Definition
| Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae |
|
|
Term
| Where do peptic ulcers most commonly occur? |
|
Definition
most commonly in the antrum of the stomach
second most commonly in the duodenum |
|
|
Term
| What's the difference between a peptic ulcer and a gastric ulcer? |
|
Definition
a gastric ulcer is any discontinuity or break in stomach epithelium due to a gastric mucosal inflammatory process.
Peptic ulcers are ulcers in the GI tract in which the defect extends through the muscularis mucosae (so some peptic ulcers are gastric ulcers, and some gastric ulcers are peptic ulcers) |
|
|
Term
|
Definition
A small bulge in the distal ileum present at birth.
It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development.
Occasionally, a Meckel's diverticulum will contain stomach mucosa (no one knows why), which will secrete stomach acid and ulcerate the unprotected small intestine. |
|
|
Term
| If you find an ulcer in the GI tract, how many more ulcers would you typically expect to find? |
|
Definition
| None. Ulcers are usually solitary. More than 2 or 3 ulcers may indicate Zollinger-Ellison syndrome. |
|
|
Term
| What would you expect to see with an endoscope if you looked at a peptic ulcer. |
|
Definition
round to oval
sharply punched-out defect
Base of ulcer is smooth and clean |
|
|
Term
| What do G cells in the stomach produce? |
|
Definition
|
|
Term
| What would you expect to see with a microscope if you looked at a biopsy of a peptic ulcer? |
|
Definition
sharply punched-out defect (mucosa on either side is unaffected)
The base of peptic ulcers is smooth and clean as a result of peptic digestion of exudates
blood vessels may be evident
In active ulcers the base may have a thin layer of fibrinoid debris underlaid by a predominantly neutrophilic inflammatory infiltrate.
Beneath this, active granulation tissue infiltrated with mononuclear leukocytes and a fibrous or collagenous scar forms the ulcer base |
|
|
Term
| Describe the pain associated with peptic ulcers. |
|
Definition
Epigastric burning or aching pain
The pain tends to occur 1 to 3 hours after meals during the day, is worse at night, and is relieved by alkali or food. |
|
|
Term
|
Definition
| pain that occurs in the top-middle region of the abdomen (the epigastrium, or epigastric region) |
|
|
Term
| What would you expect to see if you did an EGD endoscopy of a person with Zollinger-Ellison syndrome? |
|
Definition
| Multiple peptic ulcers in stomach (most commonly in the fundus, the part of the stomach between the cardia & the body) and duodenum (first part of the small intestine). |
|
|
Term
| What causes Zollinger-Ellison syndrome? |
|
Definition
| gastrin-secreting tumors, gastrinomas, that are most commonly found in the small intestine or pancreas. |
|
|
Term
| Where are the gastrin-secreting tumors that cause Zollinger-Ellison syndrome most commonly found? |
|
Definition
| in small intestine and pancreas |
|
|
Term
| What would be most remarkable about the stomach taken from the autopsy of a person who had had Zollinger-Ellison syndrome? Why? |
|
Definition
The mucosa of the stomach would be twice as thick as normal
Because Zollinger-Ellison leads to a 5-fold increase of parietal cells, as well as hyperplasia of mucous cells, and proliferation of endocrine cells within the acid-producing mucosa |
|
|
Term
| In Zollinger-Ellison, gastrin-producing tumors lead parietal cells to produce too much gastric acid, which leads to hyper-production of: |
|
Definition
|
|
Term
| You look into the stomach of a person with an endoscope and find 7 ulcers. What do you think they might have? |
|
Definition
Zollinger-Ellison syndrome
(ulcers are usually solitary, and you'll rarely find more than 2 unless the person has Zollinger-Ellison) |
|
|
Term
|
Definition
| Hypertrophic gastropathy characterized by giant cerebriform (resembling the brain) enlargement of the rugal folds due to epithelial hyperplasia without inflammation |
|
|
Term
| What causes Menetrier's disease? |
|
Definition
| excessive secretion of transforming growth factor--α (TGF-α) causes epithelial hyperplasia, which causes the rugae to grow big |
|
|
Term
| What would you expect to see if you looked at the stomach of a person with Menetrier's disease with an endoscope? |
|
Definition
Irregular enlargement of the gastric rugae in the body and fundus of the stomach (may look like brain gyri)
the antrum is generally spared.
Some areas may look like polyps. |
|
|
Term
| What would you expect to see if you used a microscope to look at a biopsy of the stomach of someone with Menetrier's disease. |
|
Definition
| Histologically, the most characteristic feature is hyperplasia of foveolar mucous cells. The glands are elongated with a corkscrew-like appearance and cystic dilation is seen. Mild inflammation, intra-epithelial lymphocytosis may be present. Diffuse or patchy glandular atrophy, evident as hypoplasia of parietal and chief cells, is typical. |
|
|
Term
| What signs and symptoms would you expect to see in a person with Menetrier's disease? |
|
Definition
low plasma protein levels
weight loss
diarrhea
peripheral edema |
|
|
Term
| Why do people with Menetrier's disease have low plasma protein levels? |
|
Definition
The altered gastric mucosa secretes massive amounts of mucus, which passes through the GI system and out of the body, losing protein from the body.
(Menetrier's--mucous cells secrete massive amounts of mucous & hyprtrophy until the rugae of the stomach look like brain gyri, increasing the total mass of the stomach significantly) |
|
|
Term
|
Definition
| nodules or masses that project above the level of the surrounding mucosa |
|
|
Term
| Are upper GI polyps common? |
|
Definition
| yes; up to 5% of upper GI endoscopies show polyps |
|
|
Term
| At what age are polyps most commonly seen? |
|
Definition
|
|
Term
| Familial adenomatous polyposis (FAP) |
|
Definition
| an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. |
|
|
Term
| What 3 acute emergencies of the GI tract can vomiting and nausea indicate? |
|
Definition
Obstruction
Perforation
Peritonitis |
|
|
Term
| What problems could vomiting and nausea lead to that are not acute emergencies but still warrant hospitalization? |
|
Definition
Dehydration
electrolyte imbalance |
|
|
Term
|
Definition
| a motor condition that affects the ability of the stomach to empty its contents |
|
|
Term
|
Definition
pressure within cells
(ex., low turgor occurs with dehydration) |
|
|
Term
| How do you asses skin turgor when you suspect dehydration? |
|
Definition
pinch skin on back of hand (or on tummy of infant). With good hydration, skin immediately returns to initial shape.
If dehydrated, the pinch will remain for a bit |
|
|
Term
| What 2 areas of the brain regulate vomiting? |
|
Definition
Area postrema
Nucleus Tractus Solitarius (NTS) |
|
|
Term
|
Definition
a part of the medulla oblongata on the floor of the fourth ventricle, which contains a chemoreceptor trigger zone sensitive to drugs, toxins, & neurotransmitter (one of the few "holes" in the blood-brain barrier)
the area postrema is one of 2 areas of the brain the stimulate vomiting (the other is the solitary nucleus) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| forceful, coordinated act of expelling gastric contents through the mouth |
|
|
Term
|
Definition
effortless movement of stomach content into the esophagus & mouth
not associated with distress or pain
individual may feel hungry immediately after
normal occurrence in neonates, treatable by child positioning, spontaneously disappears after the first several months of life |
|
|
Term
| When is regurgitation normal? |
|
Definition
in neonates
treatable by positioning child spontaneously disappears after the first several months of life |
|
|
Term
|
Definition
spasmodic movements of respiratory muscles against closed glottis and contractions of the abdominal muscles without expulsion of gastric contents
Diaphragm raises
Abdominal wall muscles constrict
Movement of gastric muscles
Relaxation of cardia |
|
|
Term
|
Definition
| chewing & swallowing of regurgitated food that has come back to the mouth within minutes of eating (not normal for human beings) |
|
|
Term
| Cephalic phase of digestion |
|
Definition
before the food reaches the stomach (while you are preparing to eat)
Initiated by the thought, image, smell, or sight of food
Initiates salivary & gastric secretions (getting more acidic) in anticipation of entry of food into the gastrointestinal system. Cephalic phase causes 30% of acid response to a meal |
|
|
Term
| The cephalic phase of digestion is mediated by innervation of the stomach via the _________________ |
|
Definition
|
|
Term
| gastric phase of digestion |
|
Definition
while the food is in the stomach (while you are eating)
Initiated by the entry of food into the stomach |
|
|
Term
| What are some stimuli that increased the acidity of the stomach lumen? |
|
Definition
anticipation of food
Stomach Distention
Ingestion of:
Peptides & Amino acids
Calcium
Alcohol (especially wine)
Caffeine
Coffee |
|
|
Term
| What happens to the lumen of the stomach when you anticipate food? |
|
Definition
it gets more acidic
(The cephalic phase causes 30% of the acid response to a meal) |
|
|
Term
| Intestinal phase of digestion |
|
Definition
after the food leaves the stomach
Most of digestion happens in this phase
Mediated by neural & humoral stimulation in the upper duodenum |
|
|
Term
|
Definition
| any cell in a many-lobed berry-like cluster, such as alveoli and the termination of exocrine glands |
|
|
Term
| How does saliva differ from plasma? |
|
Definition
hypotonic to plasma
V. low in Na+ & Cl-
High in K+ & HCO3- |
|
|
Term
| As you eat, what happens to your saliva? |
|
Definition
It becomes more abundant
It comes to resemble plasma more closely (because it doesn't spend as much time in the salivary ducts being modified) |
|
|
Term
| Saliva is filtrated from the plasma then modified in the ___________________ |
|
Definition
|
|
Term
|
Definition
| the portion of the stomach above and to the left of the cardiac orifice |
|
|
Term
| cardiac orifice of the stomach |
|
Definition
| where the esophagus empties into the stomach |
|
|
Term
|
Definition
| the part of the stomach attached to the esophagus |
|
|
Term
| When you eat, what nerve carries the afferent signal that there is food in the stomach? What nerve carries the efferent signal for the fundus to relax? What humoral signal is also used to tell the fundus to relax? |
|
Definition
Vagus nerve (CN X)
Vagus nerve (CN X)
Vasoactive Intestinal Polypeptide (VIP) |
|
|
Term
|
Definition
| GI reflexes where the afferent and efferent tracts are in the vagus nerve (CN X0 |
|
|
Term
| How will you have to change your eating habits if you have a vagotomy? |
|
Definition
| you will have to eat smaller meals because the stomach will not stretch to receive food |
|
|
Term
|
Definition
| dents in the stomach at entrances to the tubular shaped gastric glands. |
|
|
Term
|
Definition
| big cells that produce stomach acid and intrinsic factor |
|
|
Term
| If you put someone on proton-pump inhbitors, what do you need to regularly test their serum for? |
|
Definition
B12 levels
parietal cells produce stomach acid and instrinsic factor--proton-pump inhibitors inhibit both functions. If you take proton-pump inhibitors, you need to keep an eye on B12 |
|
|
Term
| Mucuous neck cells produce |
|
Definition
mucous & pepsinogen
(mucous neck cells are so-called because they reside in the upper part, or neck, of the gastric glands) |
|
|
Term
|
Definition
|
|
Term
|
Definition
stimulates the parietal cells of the stomach to secrete gastric acid (HCl)
increases motor activity in the colon |
|
|
Term
| Part of irritable bowel syndrome may be an oversensitivity to the chemical __________ |
|
Definition
gastrin
(gastrin is released when you eat a meal and increases colon motility; people with irritable bowel syndrome can often not get through a meal without going to the bathroom to have a BM) |
|
|
Term
| Enterochromaffin-like cells in the stomach produce |
|
Definition
|
|
Term
| After food enters the stomach, it's called _________ |
|
Definition
|
|
Term
| What is the primary reason that the lumen of the stomach is so acidic? |
|
Definition
| to kill bacteria that enter via the mouth |
|
|
Term
| From what part of the stomach is gastrin released, and when? |
|
Definition
| G cells deep in the gastric glands of the antrum release gastrin when food reaches the pyloric part of stomach (that is, right when you start eating--food goes to the bottom of the stomach first ) |
|
|
Term
|
Definition
• Habituation & sensitization
• Classical conditioning
• Operant conditioning
• Modeling |
|
|
Term
|
Definition
learning in which repeated stimulation decreases a response
ex., “at first the allergy shots hurt, but I got used to it” |
|
|
Term
|
Definition
learning in which unusually strong or painful stimulation causes increased a response
ex., “after the shooting, any loud noise freaks me out” |
|
|
Term
|
Definition
| stimulus that would naturally cause a response (when a dog sees food, it salivates--food is an unconditioned stimulus) |
|
|
Term
|
Definition
| natural response (ex., dog salivates b/c of food, saliva is the unconditioned response) |
|
|
Term
|
Definition
| stimulus that would not naturally cause a response (bell doesn’t naturally cause salivation) |
|
|
Term
|
Definition
| trained response to neutral stimulus by associating it with the unconditioned stimulus (salivate when bell rings) |
|
|
Term
| Acquisition (with regard to learning) |
|
Definition
| development of conditioned response to neutral stimulus |
|
|
Term
| Extinction (with regard to learning) |
|
Definition
| if you ring the bell without giving the food, you can extinguish the conditioned response |
|
|
Term
| Spontaneous recovery (with regard to learning) |
|
Definition
if a previously conditioned response was extinguished (ex., by ringing the bell multiple times without giving food), it can be revived by associating the neutral stimulus and conditioned response again (ex., by ringing the bell & giving food again)
It takes much less time to recover a conditioned response than to acquire the response in the first place |
|
|
Term
|
Definition
learn from positive or negative consequences from interaction with environment
Subject is much more active than in classical conditioning |
|
|
Term
| Fixed ratio reinforcement schedule |
|
Definition
reinforcement occurs after every X interactions with the environemnt
ex., every time toddler potties in potty, give a piece of candy |
|
|
Term
| Fixed interval reinforcement schedule |
|
Definition
reinforce behavior after fixed intervals of time
ex., for every hour a toddler is dry (during potty training), give a piece of candy |
|
|
Term
| Variable ratio reinforcement schedule |
|
Definition
Reinforce a behavior after variable repeats of the behavior
ex., slot machines |
|
|
Term
| Variable interval reinforcement schedule |
|
Definition
| reinforce behavior at varying intervals of time |
|
|
Term
| How does a fixed ratio reward reinforcement schedule affect the time of acquisition and extinguishment of behaviors? |
|
Definition
you acquire the behavior quickly, but it also extinguishes quickly
ex., if a mouse gets a treat every time it presses a bar, then it will quickly learn to press the bar. However, if it stops getting treats when it presses the bar, it will quickly lose interest. |
|
|
Term
| How does a variable ratio reward reinforcement schedule affect the time of acquisition and extinguishment of behaviors? |
|
Definition
variable ratio reinforcement leads to slow acquisition of behaviors, but also slow extinguishment
ex., if a mouse gets a treat after pressing the bar a random number of times, it will take a while to realize that it has to press the bar to get the treat. However, if it stops getting treats when it presses the bar, it will keep trying for a long time. |
|
|
Term
|
Definition
| reinforcement by adding a good thing |
|
|
Term
|
Definition
reinforcement by taking away a bad thing
negative reinforcement is NOT the same thing as punishment! |
|
|
Term
|
Definition
| unpleasant thing you do to decrease behavior |
|
|
Term
| Negative reinforcement seeks to __________ a behavior while punishment seeks to ____________ a behavior. |
|
Definition
increase
decrease
(negative reinforcement is taking away something the person doesn't like if they perform a desired behavior)
(ex., "you don't have to do your chores if you do your homework without complaining" vs. "if you complain too much about your homework, you'll have to do extra chores") |
|
|
Term
| 3 major functions of gastric acids |
|
Definition
• Bacteriostatic (most important)
• Converts pepsinogen to pepsin
• Helps digest proteins a little |
|
|
Term
| Where does the H+ for HCl in gastric acid come from |
|
Definition
CO2 + H2O <-> H2CO3 -> H+ + HCO3-
CO2 can be pulled from the blood or made in the stomach |
|
|
Term
| What happens to blood pH after a meal, and why? |
|
Definition
It becomes a little alkaline
The H+ in stomach acid is made from water and CO2 pulled from the blood. Bicarbonate is a by-product, and most of it is dumped back into the blood. Some of it is excreted by parietal cells to create a protective layer between themselves and the stomach acid.
CO2 + H2O <-> H2CO3 -> H+ + HCO3- |
|
|
Term
| What effect do histamine, gastrin, and acetylcholine have on stomach acid production separately? What effect do they have all together? |
|
Definition
separately, each slightly increases stomach acid production
together, they increase stomach acid production a LOT |
|
|
Term
| The only digestive enzyme produced in the stomach of adults |
|
Definition
| Pepsinogen (becomes pepsin) |
|
|
Term
|
Definition
"REEN-en"
an enzyme produced in the stomach of infants that curdles milk proteins and causes milk to be retained longer in the stomach than it otherwise would be |
|
|
Term
| What 2 signals stimulate the secretion of pepsinogen? |
|
Definition
Vagal stimulation as mediated by acetylcholine
Direct response to gastric acid |
|
|
Term
| What cleaves pepsinogen to form pepsin? |
|
Definition
|
|
Term
| What treatment do you need if you don’t have intrinsic factor? |
|
Definition
| B12 injections (because without intrinsic factor, you can't absorb B12 from the intestine) |
|
|
Term
| You can live without most of the stomach and not need medical treatment (as long as you eat carefully), with one exception. What is the only medical treatment that you will definitely need? |
|
Definition
you will need B12 shots
You cannot absorb B12 enterally without intrinsic factor, produced by parietal cells of the stomach. |
|
|
Term
| What are the 2 ways the gastric mucosa prevents H+ ions from leaking back into the mucosa? How else does it protect itself from stomach acid? |
|
Definition
Anatomical—cell membranes & tight junctions between cells
Physiological—diffused H+ ions are transported back to lumen
Parietal cells produce a tiny bit of HCO3- that produces a neutral layer between themselves & the acid |
|
|
Term
Explain what's wrong with the following statement: "Mucous protects the stomach muscoa from stomach acid" |
|
Definition
Mucous membrane is more to protect tissues from physical abrasion & cuts. But, if tissue is broken or damaged, underlying cells are exposed to acid, and an ulcer can start
the stomach mucosa protects itself from acid by: Anatomical—
cell membranes & tight junctions between cells
Physiological—
diffused H+ ions are transported back to lumen
Parietal cells produce a tiny bit of HCO3- that produces a neutral layer between themselves & the acid |
|
|
Term
| Main cause of stomach ulcers |
|
Definition
|
|
Term
| How does Helicobacter pylori cause stomach ulcers? |
|
Definition
It secretes agents that stick to the cell surface and break down the tight junctions between cells.
These tight juntions form an anatomical barrier between the stomach acid and the mucosa, so without them the stomach acid can enter and damage the mucosa. |
|
|
Term
| What treatments do you give someone with ulcers? |
|
Definition
Antibiotics (to kill H. pylori)
Drugs to decrease stomach acidity:
Acid pump inhibitors
Antacids
H2 receptor blockers
Surgery (rare)
Vagotomy
Antrectomy |
|
|
Term
| 95% of people with duodenal ulcers and 100% of patients with gastric ulcers have: |
|
Definition
H. pylori infection
But the majority of people have H. pylori & no ulcers—we don’t know why that is |
|
|
Term
| Can an ulcer be life threatening? |
|
Definition
| Yes. If the ulcer erodes all the way through to arteries, you can bleed out |
|
|
Term
| What are 4 common things that weaken the mucosal barrier of the stomach? |
|
Definition
H. pylori
Aspirin & other NSAIDs
Ethanol
Bile salts (from vomiting) |
|
|
Term
| What are 4 common things that strengthen the mucosal barrier of the stomach? |
|
Definition
Mucus
HCO3-
Prostaglandins (PGs)—that’s why NSAIDs cause problems
Epidermal growth factor |
|
|
Term
| Is H. pylor gram positive or gram negative? |
|
Definition
|
|
Term
| What are the 2 plexuses in the gut? |
|
Definition
Myenteric plexus
(between the longitudinal and circular layers of muscularis externa in the GI tract; provides motor innervation to both; contains sympathetic & para-sympathetic fibers)
Plexus of the Submucosa
(pierces the circular muscular layer & lies in the submucosa of the GI tract; innervates the muscularis mucosa & the mucous membrane; contains para-sympathetic fibers only) |
|
|
Term
| What is the difference between multi-unit and unitary/single unit smooth muscle? |
|
Definition
Multi-unit:
o Like skeletal muscle, each muscles cell is innervated
o No gap junctions
o Each cell must be activated to contract
Unitary/Single unit:
o Whole layer acts as one syncitium—stimultion of 1 cells causes whole layer to contract
o Contains gap junctions |
|
|
Term
| In smooth muscle, most of the Calcium comes from: |
|
Definition
outside of the cell
(this is possible because smooth muscle cells are slimmer than skeletal muscle cells) |
|
|
Term
| When Ca2+ enters smooth muscle, it binds to ___________ |
|
Definition
|
|
Term
| After Ca2+ enters smooth muscle, it binds to calmodulin (CaM), and the Ca2+-calmodulin complex activates _____________ |
|
Definition
| Myosin Light Chain Kinase (MLCK) |
|
|
Term
| In smooth muscle, _____________ phosphorylates light chains in myosin heads & increase myosin ATPase activity |
|
Definition
| Myosin Light Chain Kinase (MLCK) |
|
|
Term
| The myosin in skeletal muscle is like an old man's thing that needs Viagra to energize it. What is it's Viagra? |
|
Definition
| Myosin Light Chain Kinase (MLCK) |
|
|
Term
| Why are none of the viruses that cause gastroenteritis enveloped? |
|
Definition
| because an envelope wouldn't be able to make it through the stomach acid, so it wouldn't be good for fecal-oral transmission |
|
|
Term
| Why are all the viruses that commonly cause gastroenteritis easily transmissible on fomites? |
|
Definition
| because the lack of envelope means that they can resist dessication |
|
|
Term
| What virus is the most common cause of gastroenteritis in young children? |
|
Definition
|
|
Term
| Where does rotavirus most commonly cause outbreaks? |
|
Definition
| pre-schools, day care, and among hospitalized infants |
|
|
Term
| Which of the following is more likely to cause a fever? adenovirus rotavirus |
|
Definition
rotavirus usually causes a fever (Rotavirus Raises temperature)
adenovirus rarely causes a fever (adenovirus, NO fever) |
|
|
Term
| A 2-year-old has a fever and is throwing up. What virus do they most likely have? |
|
Definition
|
|
Term
| A 2-year-old is throwing up. They do not ever develop a fever throughout the course of their illness. What virus do they most likely have? |
|
Definition
|
|
Term
| What 2 viruses most commonly cause gastroenteritis in young children (under age 3)? |
|
Definition
|
|
Term
| A 5-year-old catches a virus and starts throwing up. Why is it probably not adenovirus or rotavirus? |
|
Definition
| Most people have had adenovirus and rotavirus by age 3 and are immune for the rest of their lives |
|
|
Term
| Who is most likely to get adenovirus? Rotavirus? Norwalk virus? |
|
Definition
adenovirus & rotavirus--most likely children < age 3
Norwalk virus--older children & adults |
|
|
Term
| What family does adenovirus belong to? |
|
Definition
|
|
Term
| What family does hepatitis A belong to? |
|
Definition
|
|
Term
| What family does rotavirus belong to? |
|
Definition
|
|
Term
| What family does calicivirus belong to? |
|
Definition
|
|
Term
| What family does Norovirus (aka Norwalk virus) belong to? |
|
Definition
|
|
Term
| What family does astrovirus belong to? |
|
Definition
|
|
Term
| Describe the envelope, capsid, & genome morphology of adenovirus. |
|
Definition
naked
deltaicosahedral capsid
linear dsDNA |
|
|
Term
| Describe the envelope, capsid, & genome morphology of hepatitis A virus. |
|
Definition
naked
icosahedral capsi
(+)ssRNA |
|
|
Term
| Describe the envelope, capsid, & genome morphology of rotavirus . |
|
Definition
naked
3-layered icosahedral capsid
11 segs of dsRNA |
|
|
Term
| Describe the envelope, capsid, & genome morphology of calicivirus |
|
Definition
naked
hexagonal/spherical icosahedral capsid
(+)ssRNA |
|
|
Term
| Describe the envelope, capsid, & genome morphology of Norovirus (Norwalk virus). |
|
Definition
| naked hexagonal/spherical icosahedral capsid (+)ssRNA (it's a member of the caliciviridae family, so these are the same as calicivirus) |
|
|
Term
| Describe the envelope, capsid, & genome morphology of Astrovirus |
|
Definition
naked
icosahedral capsid
(+)ssRNA |
|
|
Term
| Reoviridae, such as rotavirus, unlike many viruses, need to produce their own ____ because of the type of cells they infect. Explain. |
|
Definition
polymerase
because they infect terminally differentiated enterocytes near the tips of villi in the small intestine. These cells don't express polymerase because they are non-dividing |
|
|
Term
| What does VP4 on reoviridae, such as rotavirus, do? |
|
Definition
| it is a spike protein on the surface of the capsid that helps the virus bond to and enter the cell |
|
|
Term
| A reoviridae, such as rotavirus, has an outer capside made of the glycoprotein ________, covered with spikes of the protein _________ |
|
Definition
|
|
Term
| By the time rotavirus gets into the cell, how many capsid layers does it have? |
|
Definition
| 2 (the outer capsid is lost in entering the cell) |
|
|
Term
| Why do reoviridae, such as rotavirus, need to increase Ca2+ within an infected cell? |
|
Definition
| because Ca2+ is necessary to form VP7, the glycoprotein that makes up the outer capsid |
|
|
Term
| What do reoviridae, such as rotavirus, use NSP4 protein for? |
|
Definition
causes cell to release Ca2+ from endoplasmic reticulum (which causes cell to dump water & Cl-, which causes diarrhea)
disrupts tight junctions, allowing H2O and electrolytes to flow between adjacent cells
stimulates enteric nervous system |
|
|
Term
| What are the palpable bones of the abdomen? |
|
Definition
xyphoid process
costal margin
tubercle of the iliac crest
anterior superior iliac spine
pubic tubercle
pubic crest
pubic symphysis |
|
|
Term
|
Definition
| a transverse plane of the abdomen beneath the lowest point of the costal margin |
|
|
Term
|
Definition
| a transverse plane of the abdomen that passes through the iliac tubercles (at the level of L5) |
|
|
Term
| Right hypochondriac region |
|
Definition
above the subcostal plane, right of the right midclavicular line
(Hypochondria “under the cartilage (of the breastbone)”) |
|
|
Term
|
Definition
above the subcostal plane, between the right & left midclavicular lines
(Epigastric “over the belly” ) |
|
|
Term
| Left hypochondriac region of the abdomen |
|
Definition
| above the subcostal plane, left of the left midclavicular line |
|
|
Term
| Left lumbar region of the abdomen |
|
Definition
| between the subcostal plane & the transtubercular plane, left of the left midclavicular line |
|
|
Term
| Umbilical region of the abdomen |
|
Definition
| between the subcostal plane & the transtubercular plane, between the right and left midclavicular lines (umbilicus is about in the middle) |
|
|
Term
| Right lumbar region of the abdomen |
|
Definition
| between the subcostal plane & the transtubercular plane, right of the right midclavicular line |
|
|
Term
| Right inguinal region of the abdomen |
|
Definition
| below the transtubercular plane, right of the right midclavicular line |
|
|
Term
| Hypogastric region of the abdomen |
|
Definition
below the transtubercular plane, between the left & right midclavicular line
(Hypogastric “under the belly”) |
|
|
Term
| Left inguinal region of the abdomen |
|
Definition
| below the transtubercular plane, left of the left midclavicular line |
|
|
Term
|
Definition
fatty layer directly under the skin of the abdomen
(you need a fatty layer to keep warm if you're going to go camping) |
|
|
Term
|
Definition
| Membranous layer (fibrous connective tissue) under the subcutaneous fat in the abdomen. Continuous with other, named fascias in the perineum |
|
|
Term
| What are the 9 layers of the abdominal wall from outer to inner (at the front-side of the abdomen) |
|
Definition
Skin
Camper’s fascia—fatty layer directly under the skin of the abdomen
Scarpa’s fascia—membranous layer (fibrous connective tissue under the subcutaneous fat in the abdomen. Continuous with other, named fascias in the perineum)
External oblique muscle
Internal oblique muscle
Transverses abdominis muscles
Transversalis fascia
Extraperitoneal fascia
Parietal peritoneum |
|
|
Term
|
Definition
| the upper, lateral end of the inguinal canal |
|
|
Term
| Superficial inguinal ring |
|
Definition
| the lower, medial end of the inguinal canal |
|
|
Term
| What 3 muscles make up the inguinal canal? |
|
Definition
| external oblique, internal oblique, & transverse abdominis |
|
|
Term
| The inguinal canal is wider in ______ |
|
Definition
|
|
Term
| In males, what does the inguinal canal carry? |
|
Definition
| the spermatic cord (vas deferens + surrounding tissue) |
|
|
Term
|
Definition
| vas deferens + surrounding tissue |
|
|
Term
| The vas deferens (aka ductus deferens) carries sperm from the _________ to the __________ |
|
Definition
|
|
Term
The testes and penis are right next to each other, yet the vas deferens has a somewhat circuitous pathway. What is this pathway, and why is it circuitous?
|
|
Definition
the vas deferens leaves the testes, goes up the inguinal canal, into the abdomen, and back down to the penis
During fetal development, the testes develop in the abdomen. During this time the path from the testes to the penis is more of a straight shot. However, at some point during development, the testes descend through the inguinal canal into the scrotum, dragging the vas deferens after them. |
|
|
Term
| In females, the inguinal canal contains the: |
|
Definition
| round ligament of the uterus |
|
|
Term
| Round ligament of the uterus |
|
Definition
| starts at the uterine horns, passes through the inguinal canal and continues on to the labia majora where its fibers spread and mix with the tissue of the mons pubis. |
|
|
Term
|
Definition
| when part of the intestine protrudes through a weak spot in the inguinal canal or in the inguinal triangle |
|
|
Term
| Who is more likely to get inguinal hernias, and why? |
|
Definition
| males, because their inguinal canal is bigger than women's |
|
|
Term
| Are indirect or direct inguinal hernias more common? |
|
Definition
|
|
Term
|
Definition
| • intestine passes through the (congenitally open) deep inguinal ring, inguinal canal, and superficial ring, and descends into the scrotum |
|
|
Term
| What causes an indirect inguinal hernia? (Why is the intestine able to enter the inguinal canal?) |
|
Definition
| the deep inguinal ring fails to close during embryonic development after the testicle has passed through it. |
|
|
Term
| The intestine descends all the way to the scrotum in ________ (direct/indirect) inguinal hernias. |
|
Definition
|
|
Term
| Are indirect inguinal hernias developed during life, or are they congenital? |
|
Definition
|
|
Term
|
Definition
| intestine is pushed through a weakened area of the abdominal wall muscles (posterior wall of the inguinal canal), but does not descend into the scrotum |
|
|
Term
| Are direct inguinal hernias acquired during life, or are they congenital? |
|
Definition
| acquired during life (although the weakenss in the posterior wall of the inguinal canal may be congenital) |
|
|
Term
| In which kind of inguinal hernia is the protruding intestine surrounded by a sac of peritoneum? |
|
Definition
|
|
Term
| The rectus sheath is formed by the fusion of the aponeuroses of what 3 muscles? |
|
Definition
external oblique
internal oblique
transverse abdominis |
|
|
Term
| What is the relationship between the rectus sheath and the rectus abdominis in the upper abdomen? In the lower abdomen? |
|
Definition
upper abdomen--surrounds the rectus abdominis
lower abdomen--passes in front of the rectus abdominis |
|
|
Term
| The iliohypogastric nerve arises from what nerve root? |
|
Definition
|
|
Term
| The iliohypogastric nerve innervates the __________ and _____________ muscles. |
|
Definition
internal oblique muscle
transverse muscle |
|
|
Term
| The iliohypogastric nerve divides into 2 branches: |
|
Definition
the lateral cutaneous nerve
the anterior cutaneous nerve |
|
|
Term
| What skin does the lateral cutaneous branch of the iliohypogastric nerve innervate? |
|
Definition
| skin on the lateral side of the buttocks |
|
|
Term
| What skin does the anterior cutaneous branch of the iliohypogastric nerve innervate? |
|
Definition
| the skin superficial to the pubis |
|
|
Term
| What nerve root does the ilioinguinal nerve arise from? |
|
Definition
|
|
Term
| What 2 muscles does the ilioinguinal nerve innervate? |
|
Definition
the internal oblique muscle
the transverse oblique muscle |
|
|
Term
| What 2 branches does the ilioinguinal nerve give rise to? |
|
Definition
| the femoral branch the anterior scrotal nerve |
|
|
Term
| What skin does the femoral branch of the ilioinguinal nerve innervate? |
|
Definition
| the upper anterior and medial parts of the thigh |
|
|
Term
| What skin does the anterior scrotal nerve innervate in men? In women? |
|
Definition
o in men, innervates the skin at the root of the penis & the anterior part of the scrotum
in women, innerves the skin of the mons pubis and the labium majus (pl., labium majora) |
|
|
Term
| The autonomic nervous system innervates _________ muscle, _______ muscle, and __________ |
|
Definition
|
|
Term
| Each pathway in the autonomic nervous system involves ___ (#) neurons, which are: |
|
Definition
2
pre-ganglionic neuron
post-ganlionic neuron |
|
|
Term
| The __________ nervous system provides the fight-or-flight response. |
|
Definition
|
|
Term
What effect does sympathetic innervation have on the following:
heart rate
bronchial lumen
coronary arteries
hair follicles
sweat glands |
|
Definition
increases heart rate
dilates bronchial lumen
dilates coronary arteries
raises erector pili muscles in hair follicles
increases sweat |
|
|
Term
| Where are the cell bodies of the pre-ganglionic (primary) neuron of the sympathetic system? |
|
Definition
| in the lateral horn or intermediolateral cell column of spinal cord segments T1 - T3 |
|
|
Term
| The fibers of the pre-ganglionic (primary) neuron of the sympathetic system exit the spine via the? |
|
Definition
|
|
Term
| After passing through the white rami communicantes, fibers of the pre-ganglionic nerve of the sympathetic system synapse on the post-ganglionic nureon in: |
|
Definition
| a sympathetic chain ganglion |
|
|
Term
| Where is the cell body of the post-ganglionic (secondary) neuron of the autonomic nervous system? |
|
Definition
| in a sympathetic chain ganglion |
|
|
Term
| Fibers of the post-ganglionic (secondary) nerve of the sympathetic nervous system leave the sympathetic chain ganglion & join each nerve via the: |
|
Definition
|
|
Term
|
Definition
| a pair of bundled sympathetic post-ganglionic nerve fibers and visceral afferant fibers that travel down either side of the vertebra |
|
|
Term
| general visceral afferent (GVA) fibers |
|
Definition
| conduct sensory impulses (usually pain or reflex sensations) from the viscera, glands, and blood vessels to the central nervous system |
|
|
Term
| What fibers are carried in the sympathetic trunk? |
|
Definition
ascending & descending pre-ganglionic sympathetic fibers
visceral afferent fibers |
|
|
Term
| formed by fusion of the inferior cervical ganglion with the first thoracic ganglion |
|
Definition
| cervicothoracic (stellate) ganglion |
|
|
Term
| Which are more widely distributed over the body: sympathetic or para-sympathetic fibers. |
|
Definition
|
|
Term
| Pre-ganglionic (first-order neuron) cell bodies of the __________ nervous system are located in intermediolateral cell column (mostly) or lateral horn of spinal cord segments T1-T3 |
|
Definition
|
|
Term
| What nerve root innervates the skin overlying the tip of the xiphoid process? |
|
Definition
|
|
Term
| What nerve root innervates the skin of the umbilicus? |
|
Definition
|
|
Term
| What nerve root innervates the skin just superior to the pubic symphysis? |
|
Definition
|
|
Term
| What nerve root innervates the skin overlying the pubic symphisis? |
|
Definition
|
|
Term
| The external obliques are superficial the the _________ _________ |
|
Definition
|
|
Term
| What 2 nerves innervate the external obliques? |
|
Definition
thoracoabdominal nerves
subcostal nerve |
|
|
Term
| What nerve roots feed into the thoracoabdominal nerves? |
|
Definition
|
|
Term
| What do the external obliques do? |
|
Definition
Compresses & supports abdominal viscera
Flexes & rotates trunk
Active in forced expiration |
|
|
Term
| The internal obliques are deep to the ____________________, superficial to the ___________________ |
|
Definition
| Deep to the external oblique, superficial to the transverses abdominis |
|
|
Term
| What 2 nerves innervate the Internal obliques? |
|
Definition
Thoracoabdominal nerves
L1 nerves
(same as transverse abdominis) |
|
|
Term
| What do the internal obliques do? |
|
Definition
Compresses & supports abdominal viscera
Flexes & rotates trunk |
|
|
Term
| The transverse abdominus is deep to: |
|
Definition
|
|
Term
| What 2 nerves innervate the transverse abdominus? |
|
Definition
Thoracoabdominal nerves
L1 nerves
(same as internal oblique) |
|
|
Term
| What are the main actions of the transverse abdominis? |
|
Definition
Compresses & supports abdominal viscera
Depresses ribs (for forced expiration) |
|
|
Term
| The rectus abdominis is in the center of the abdomen superficial to the ____________________ |
|
Definition
|
|
Term
| What nerves innervate the rectus abdominis? |
|
Definition
| Thoracoabdominal nerves (anterior rami of the T6-T12 spinal nerves) |
|
|
Term
| What does the rectus abdominis do? |
|
Definition
Flexes trunk (lumbar vertebrae)
Compresses abdominal viscera
Stabilizes & controls tilt of pelvis (anti-lordosis)
Depresses ribs (for forced expiration) |
|
|
Term
| The superficial epigastric artery arises from the __________________ |
|
Definition
| femoral artery (the large artery of the hip & thigh) |
|
|
Term
| The superficial epigastric artery supplies: |
|
Definition
| the superficial abdominal wall of the pubic & inferior umbilical regions |
|
|
Term
| What artery supplies the superficial abdominal wall of the pubic & inferior umbilical regions? |
|
Definition
| superficial epigastric artery |
|
|
Term
| The superior epigastric artery is a direct continuation of the: |
|
Definition
|
|
Term
| The superior epigastric artery supplies: |
|
Definition
| the superior half of the rectus abdominis muscle |
|
|
Term
| What artery supplies the superior half of the rectus abdominis muscle? |
|
Definition
| superior epigastric artery |
|
|
Term
| The inferior epigastric artery arises from the: |
|
Definition
|
|
Term
| The inferior epigastric artery supplies the: |
|
Definition
| inferior half of the rectus abdominis muscle |
|
|
Term
| What artery supplies the inferior half of the rectus abdominis muscle? |
|
Definition
| inferior epigastric artery |
|
|
Term
| What artery is located within the layer of extraperitoneal fascia posterior to the spermatic cord or round ligament of the uterus? |
|
Definition
| inferior epigastric artery |
|
|
Term
| In the anterior abdominal wall, superficial lymphatic vessels superior to transumbilical plane primarily drain to _____________________ lymph nodes, though a few drain to _______________________ lymph nodes |
|
Definition
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Term
| In the anterior abdominal wall, superficial lymphatic vessels inferior to the transumbilical plane drain to __________________________ lymph nodes |
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Definition
| superficial inguinal lymph nodes |
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Term
| _________ lymph nodes are located at the anterior ends of the intercostal spaces |
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Definition
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Term
| Deep lymphatic vessels of the anterior abdominal wall drain to what 4 groups of lymph nodes? |
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Definition
external iliac lymph nodes
common iliac lymph nodes
right lumbar lymph nodes
left lumbar lymph nodes |
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Term
| What venous plexus drains the skin and subcutaneous tissue of the anterior abdominal wall? |
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Definition
subcutaneous venous plexus
(the subcutaneous venous plexus drains skin over much or all of the body) |
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Term
| In the anterior abdomen the subcutaneous venous plexus drains superiorly to the _____________ vein and _______________ vein, and inferiorly to the _____________ vein and ______________ vein |
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Definition
internal thoracic vein
lateral thoracic vein
superficial epigastric vein
inferior epigastric veing |
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Term
| At what age are you most likely to get chronic gastritis? What gender is more likely to get them? |
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Definition
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Term
| What 2 illnesses most pre-dispose a person to gastric adenoma? |
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Definition
Familial Adenomateous Polyposis (FAP)
chronic gastritis |
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Term
| What you see if you looked with an endoscope at the stomach of a person with gastric adenoma? |
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Definition
| solitary lesions <2cm in diameter, most commonly located in the antrum |
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Term
| Below the body of the stomach, but above the pylorus is the _______ __________ |
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Definition
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Term
| What would you see if you looked at a biopsy of a gastric adenoma with a microscope? |
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Definition
Gastric adenomas are composed of intestinal-type columnar epithelium
epithelial dysplasia is always present
(recall: dysplasia is abnormal cell development marked by Anisocytosis—cells of unequal size, Poikilocytosis—abnormally shaped cells, Hyperchromatism, and presence of mitotic figures—an unusual # of cells which are currently dividing) |
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Term
| What signs and symptoms might a person with gastric adenoma present with? |
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Definition
may be asymptomatic
may present with nausea, vomiting, or epigastric pain |
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Term
| In what 2 geographical locations is the incidence of gastric adenoma highest? |
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Definition
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Term
| Most common malignancy of the stomach, comprising over 90% of all gastric cancers. |
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Definition
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Term
| What are risk factors for gastric adenocarcinoma? |
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Definition
highest incidence in Japan & Eastern Europe
low fiber diet
dietary carcinogens (N-nitroso compounds and benzo[a]pyrene) for food preservation
Familial Adenomatous Polyposis |
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Term
| "Doc, my mom had stomach cancer, gastric adenocarcinoma. Now you say I've got an ulcer from H. pylori, but it's not cancer. Is this ulcer gonna give me cancer?" |
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Definition
| ulcers can be confused with cancer, but Peptic Ulcer Disease does NOT predispose a person to adenocarcinoma. |
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Term
| How can you reduce your risk of gastric adenocarcinoma? |
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Definition
| eat a lot of green, leafy vegetables and citrus fruits, which contain antioxidants such as vitamin C, vitamin E, and beta-carotene |
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Term
| What would you see if you looked with an endoscope in the stomach of someone with intestinal-type gastric adenocarcinoma? |
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Definition
| bulky tumors, exophytic (growing outward) mass, ulcerated tumor |
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Term
| What would you see if you looked with an endoscope into the stomach of a person with diffuse gastric adenocarcinoma? |
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Definition
plastic texture
mass is difficult to locate
when there are large areas of infiltration, diffuse rugal flattening & a rigid, thickened wall may impart a "leather bottle" appearance |
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Term
| What are the 2 main types of gastric adenocarcinoma? |
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Definition
intestinal-type gastric adenocarcinoma
diffuse gastric adenocarcinoma |
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Term
| What would you see if you looked with a microscope at a biopsy of intestinal-type gastric adenocarcinoma? |
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Definition
columnar, gland-forming cells infiltrating through desmoplastic stroma
(desmoplastic stroma: fibrosis induced around some types of cancer) |
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Term
| What would you see if you looked with a microscope at a biopsy of diffuse gastric adenocarcinoma? |
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Definition
| signet-ring cells can be rocognized by their large cytoplasmic mucin vacuoles and peripherally displaced, crescent-shaped nuclei |
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Term
Describe signet-ring cells.
What are they a hallmark of? |
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Definition
signet-ring cells can be rocognized by their large cytoplasmic mucin vacuoles and peripherally displaced, crescent-shaped nuclei
diffuse gastric adenocarcinoma. |
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Term
| What signs & symptoms might a person with gastric adenocarcinoma present with? |
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Definition
epigastric pain
GI blood loss
nausea
vomiting
obstruction (if it tends to grow out in a mass--intestinal-type)
signs & symptoms of gastroparesis |
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Term
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Definition
carcinoid tumors arise from the diffuse components of the endocrine system
(ex., the tumors reponsible for Zollinger-Ellison Syndrome may be carcinoid tumors) |
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Term
| At what age do carcinoid tumors most frequently appear? |
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Definition
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Term
| Where are carcinoid tumors most likely to occur? |
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Definition
the majority are found in the GI tract (especially the small intestine)
2nd most common site: tracheobronchial tree & lungs |
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Term
| Where in the stomach do carinoid tumors most commonly occur? |
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Definition
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Term
| Grossly, what do carcinoid tumors look like? |
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Definition
intramural or submucosal masses that creat small polypoid lesions
the overlying mucosa may be intact or ulcertaed
the tumors may invade deeply to involve the msentery
tend to be yellow or tan in color
very firm as a consequence of desmoplastic reaction (meaning that the tumor induces fibrosis in surround tissue), which may cuase kinking of hte bowl and obstruction |
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Term
| What does a biopsy of a carcinoid tumor look like, microscopically? |
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Definition
islands, trabeculae (rods), strands, glands, or sheets of uniform cells with scant, pink granular cytoplasm and a round to oval stippled nucleus
in most tumors, there is minimal pleomorphism |
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Term
| What are the clinical features of carcinoid tumor? |
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Definition
determined by the hormones
gastrin-producing carcinoids may cause Zollinger-Ellison Syndrome
Ileal carcinoids produce cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right-sided cardiac vulvular fibrosis |
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Term
Explain the following mnemonic:
Cushing is Pushing; Curling is Burning |
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Definition
Cushing’s ulcers are gastric (stomach, dudodenum, distal esophagus) stress ulcers as the the result of high intracranial pressure (pushing)
Curling ulcers are stress ulcers in the duodenum as the result of severe burns to the surface of the body |
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Term
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Definition
| a thin layer of loose connective tissue which lies beneath the epithelium and together with the epithelium constitutes the mucosa |
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Term
Fill in and explain the following mnemonic:
Rotavirus Raises _____
AdeNOvirus, NO _______ |
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Definition
Rotavirus Raises Temp
AdeNOvirus, NO Fever
Rotavirus & Adenovirus are the most common causes of GI infection in babies and children up to age 3. They have very similar symptoms, except that Rotavirus causes a fever, and Adenovirus does not. |
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Term
Explain the following mnemonic:
INdirect is INborn
Direct Develops later |
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Definition
An indirect inguinal hernia is present from birth. It is due to a developmental error in the embryo, in which the deep inguinal ring fails to close after the testicle has passed through it. The intestine pushes through the deep inguinal ring during development and extends into the scrotal sac at birth.
A direct hernia develops after birth, when the intestine pushes through the posterior wall of the inguinial canal. The weakness in the posterior wall, though, may be congenital or may develop later.
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Term
| What 3 chemicals induce the parietal cells to produce stomach acid? |
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Definition
histamine
gastrin (from parietal cells)
acetylcholine (from innervation by the vagus nerve)
Together, the 3 chemicals have a much stronger effect on acid production than any of them has individually. |
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